2 November 2008

Calpol Night & Diphenhydramine: Doubts & Information

Previously Posted here " Gonçalo Amaral in El Mundo: Gerry McCann hid Madeleine corpse in the Beach"

Image from the Calpol Official site

Also for the record, according the data sheet in the electronic Medicines Compendium (eMC) - Date of Authorisation/Renewal of Authorisation for Calpol Night was 12th January 2007. (Download PDF here)


Regarding the word 'somnífero' in Spanish I translated it first to 'sleeping pill/sleeping' draught' - which is the verbatim translation. I didn't now that Calpol was a liquid solution, and I also didn't know that Calpol is not prescribed in the pills form however as someone told me that Calpol is sold in a liquid form I amended the translation from 'sleeping pill' to 'Calpol - sleeping solution'. Calpol is not sold in Portugal any more as the license was revoked.

In fact I never used the product or seen a box or whatever is used to contain the product, except on the Official site for Calpol.


You can read here what the Infarmed has about Calpol. Infarmed is the national body responsible for the introduction of medicaments in the Portuguese market. It just says Oral suspension, it does not specify if it is a liquid, a powder, or a pill; states that is packaged inside a bottle, the Anatomical Therapeutical Chemical is N02BE01 PARACETAMOL, and the therapeutical use is 2.10 Analgésicos e antipiréticos - that is analgesics, also known as painkillers and antipyretics, used to reduce a fever.

From the wikipedia on Calpol : Calpol is a brand of children's medicine sold in the UK, Ireland, India and Cyprus. The main product is a paracetamol suspension. It is usually a coloured syrup with a sweet taste, used to treat fever and pain. It was owned by Mark Profad, the president of the company and Paul Knott, his vice president. Calpol also comes in a form containing ibuprofen, marketed under the name Calprofen.

From the Calpol official site which is owned by a UK based company we can read the following on Calpol and specifically on Calpol Night:



- Suitable for children from 2 years plus
- Relieves pain and reduces fever
- Also aids restful sleep
- Strawberry flavour
- Sugar-free and colour-free
- Available in bottles
- Each pack contains a double-ended measuring thingy


CALPOL® Night is our first formulation developed especially for use at night time, it is a paracetamol-based liquid medicine suitable for children aged 2 years plus. It provides fast, effective relief from pain and fever and other childhood ailments such as teething pain, and symptoms of flu and feverish colds. It also contains a sedating antihistamine called diphenhydramine which helps your child to settle and have a restful night's sleep – and sleep plays an important part in any healing process. Every pack contains a double-ended measuring sthingy, making it easy for you to give your child the right amount. The larger end will hold 5ml, the smaller end holds 2.5ml. With a tasty strawberry flavour, it contains no sugar or added colour.

Notice that CALPOL® Night* also contains a sedating antihistamine called diphenhydramine as one of the two main ingredients, the other being Paracetemol.

So what is exactly Diphenhydramine?

From the Wikepedia, again, we can read the Side Effects and that one of the possible uses is a recreational one.

Diphenhydramine

Recreational use

Diphenhydramine is used both clinically and recreationally in conjunction with opioids to relieve itching and act as an analgesia potentiator [9] in a dose of 100-800 mg depending on body size and length of diphenhydramine use. It is used recreationally as a deliriant, depressant, or booster for alcohol. Mixing medications with sedating antihistamines other than under medical supervision can be quite dangerous.

Those who use diphenhydramine recreationally take a higher dose than recommended. In smaller recreational doses (100-250mg) the side effects are mild and are mainly limited to sleepiness and labored breath. The mental effects of higher doses (250+mg) are described by many as "dreaming while awake"[10] involving visual and auditory hallucinations that, unlike those experienced with most psychedelic drugs, often cannot be readily distinguished from reality. People who consume a high recreational dose can possibly find themselves in a hallucination which places them in a familiar situation with people and friends and rooms they know, while in reality being in a totally different setting.

Many users report a side effect profile consistent with atropine intoxication.This is due to antagonism of muscarinic acetylcholine receptors in both the central and autonomic nervous system which inhibits various signal transduction pathways. In the CNS, diphenhydramine readily crosses the blood-brain barrier, exerting effects within the visual and auditory cortex.

Other CNS effects occur within the limbic system and hippocampus, causing confusion and temporary amnesia. Toxicology also manifests in the autonomic nervous system, primarily at the neuromuscular junction, resulting in ataxia and extrapyramidal side-effects, and at sympathetic post-ganglionic junctions, causing urinary retention, pupil dilation, tachycardia, irregular urination, and dry skin and mucous membranes. Considerable overdosage can lead to myocardial infarction (heart attack), serious ventricular dysrhythmias, coma and death. Such a side-effect profile is thought to give ethanolamine-class antihistamines a relatively low abuse liability. The specific antidote for diphenhydramine poisoning is physostigmine, usually given by IV in hospital.

Side effects

Like many other first-generation antihistamines, diphenhydramine is a potent anticholinergic agent. This leads to profound drowsiness as a very common side-effect, along with the possibilities of motor impairment (ataxia), dry mouth and throat, flushed skin, rapid or irregular heartbeat (tachycardia), blurred vision at nearpoint owing to lack of accommodation (cycloplegia), abnormal sensitivity to bright light (photophobia), pupil dilation (mydriasis), urinary retention (ischuria), constipation, difficulty concentrating, short-term memory loss, visual disturbances, hallucinations, irritability, itchy skin, confusion, erectile dysfunction, and delirium. Some side effects such as twitching may be delayed until the drowsiness begins to cease and the person is in more of an awakening mode. Diphenhydramine also has local anesthetic properties, and has been used for patients allergic to common local anesthetics like lidocaine.[6] Severe, prolonged twitching and muscle spasm have also been experienced.

The most common cardiac dysrhythmias associated with diphenhydramine overdose are sinus bradycardia, elongated S-T segment interval, and premature ventricular contraction.

From the Drugs and Human Performance Fact Sheets we can read :

Diphenhydramine

Diphenhydramine is a white, crystalline powder. Available primarily in tablet, capsule and liquid form.

Synonyms: 2-(diphenylmethoxy)-N,N-dimethylethylamine hydrochloride; diphenhydramine hydrochloride; Benadryl®, Unisom® Sleepgels, Dytuss®, Dramamine®.

Source: Available in capsules, tablets, chewable tablets, syrups, elixirs, topical, and injectable forms in a variety of prescription and over-the-counter medications. Products contain diphenhydramine alone or in combination with other drugs such as pseudoephedrine and acetaminophen. Diphenhydramine is also an ingredient in several Tylenol® (i.e., acetaminophen) preparations. Dimenhydrinate (Dramamine®) is a combination of diphenhydramine and 8-chlorotheophylline in equal molecular proportions.

Drug Class: Antihistamine, antiemetic, sleep aid, sedative, CNS depressant.

Medical and Recreational Uses: Used as an antihistamine for the temporary relief of seasonal and perennial allergy symptoms. Diphenhydramine is also used as a sleep aid and a cough suppressant, and has been used as a centrally acting antitussive although the mechanism for this action is unclear. Dramamine is used as a prophylaxis against and for the treatment of motion sickness.

Potency, Purity and Dose: As an antihistamine, recommended doses for adults is 25-50 mg diphenhydramine every 6-8 hours, not to exceed 50-100 mg every 4-6 hours. For children, 12.5-25 mg three or four times daily is recommended. As a sleep aid the dose is 50 mg at bedtime. Adults can be given 10-50 mg intravenously or intramuscularly, up to a maximum daily dose of 400 mg.
Route of Administration: Oral, injected, and topical applications.

Pharmacodynamics: Diphenhydramine is a first generation antihistamine and is a H 1 receptor antagonist. Antagonism is achieved through blocking the effect of histamine more than blocking its production or release. Diphenhydramine inhibits most responses of smooth muscle to histamine and the vasoconstrictor effects of histamine. The antagonism may also produce anticholinergic effects, antiemetic effects, and significant sedative side effects.

Pharmacokinetics: Following oral administration diphenhydramine is well absorbed from the gastrointestinal tract, is widely distributed throughout the body, and is able to pass though the blood-brain barrier. The oral availability is 61%, and 78% is bound in plasma. Peak plasma concentrations are reached in 2-3 hours. Diphenhydramine is metabolized to nordiphenhydramine (active metabolite), dinordiphenhydramine, and diphenylmethoxyacetic acid. The plasma half-life is 8.5±3.2 hours; shorter and longer half-lives have been reported for children and elderly subjects, respectively. Urinary excretion of unchanged diphenhydramine is 1.9%.

Molecular Interactions / Receptor Chemistry: Diphenhydramine is metabolized via cytochrome P450 2D6 isoenzyme. Potential inhibitors of P450 2D6 could decrease the rate of drug elimination if administered concurrently, while potential inducers could increase the rate of drug elimination.

Blood to Plasma Concentration Ratio: 0.77 and 0.82 reported.

Interpretation of Blood Concentrations: Following a single oral dose of 50 mg, average peak plasma concentrations of 83 ng/mL diphenhydramine were detected at 3 hours, declining to 9 ng/mL by 24 hours. A single oral 100 mg dose resulted in average peak plasma concentrations of 112 ng/mL at 2 hours post dose. Effective antihistamine concentrations are greater than 25 ng/mL, drowsiness can be observed at 30-40 ng/mL, and mental impairment may be observed with concentrations above 60 ng/mL.

Interpretation of Urine Test Results: Less than 2% of an oral dose is excreted in the 24 hour urine as unchanged parent drug, while approximately 11% is eliminated as its glucuronide conjugate.

Effects: First generation H 1 antagonists can both stimulate and depress the CNS. Stimulation results in restlessness, nervousness and inability to sleep, while depressive effects include diminished alertness, slowed reaction time and somnolence. Diphenhydramine is particularly prone to cause marked sedation. Drowsiness, reduced wakefulness, altered mood, impaired cognitive and psychomotor performance may also be observed.

Side Effect Profile: Includes agitation, anticholinergic side effects such as dry mouth, confusion, dizziness, drowsiness, fatigue, disturbed coordination, irritability, paresthesia, blurred vision, and depression. In overdose, symptoms may include excitement, ataxia, tremor, sinus tachycardia, fever, hallucination, athetosis, convulsions or seizures, hypotension, deep coma, cardiorespiratory collapse, and death. Fixed and dilated pupils are also observed. Gastrointestinal symptoms are less with diphenhydramine than with other H 1 antagonists.

Duration of Effects: Dose-dependent, however, following oral administration of therapeutic doses, peak plasma concentrations are reached in 2-3 hours and effects usually last 4-6 hours.

Tolerance, Dependence and Withdrawal Effects: Some tolerance may develop to the sedative effects of diphenhydramine with repeated oral dosing. No reported dependence or withdrawal effects with doses recommended.

Drug Interactions: Effects of diphenhydramine are increased by the presence of alcohol, MAOI’s, diazepam, hypnotics, sedatives, tranquilizers, and other CNS depressants. Alcohol enhances such effects as drowsiness, sedation and decreased motor skills. These decrements in effect are more pronounced in the elderly.

MAOI’s prolong and intensify the anticholinergic effects of diphenhydramine.

Performance Effects: All first generation antihistamines, including diphenhydramine, have been demonstrated to diminish cognitive and psychomotor performance in healthy volunteers. Impairment might even be of greater clinical significance in patients when the allergic disorder per se adversely affects CNS function, as suggested in studies in which a reduction in cognitive functioning in patients was exacerbated by diphenhydramine . Laboratory studies have shown diphenhydramine to decrease alertness, decrease reaction time, induce somnolence, impair concentration, impair time estimation, impair tracking, decrease learning ability, and impair attention and memory within the first 2-3 hours post dose. Significant adverse effects on vigilance, divided attention, working memory, and psychomotor performance have been demonstrated. It is important to note that impairment has been shown to occur even in the absence of self-reported sleepiness or sedation. Concurrent use of diazepam and diphenhydramine caused significant performance decrements at 2 hours, and to some degree up to 4 hours.

Effects on Driving: The drug manufacturer states that p atients should be warned about engaging in activities requiring mental alertness such as driving a car. Diphenhydramine has repeatedly been shown to severely impair tracking and reaction time performance in actual on-the-road driving tests. Single doses of 50 mg have been shown to cause significant impairment during a 90 km highway test (measuring vehicle following, constant speed and lateral position). In contrast, single 25-100 mg doses caused no significant driving effects during a short 15 minute driving test. Using the Iowa Driving Simulator, Weiler et al, 2000 compared the effects of a single oral dose of 50 mg diphenhydramine to the effects corresponding to a blood alcohol concentration of 0.1 g/100 mL. Diphenhydramine caused significantly less coherence (ability to maintain a constant distance) and impaired lane keeping (steering instability and crossing center line) compared to alcohol. Overall driving performance was the poorest after taking diphenhydramine, and participants were most drowsy after taking diphenhydramine (before and after testing). The authors concluded that diphenhydramine clearly impairs driving performance, and may have an even greater impact than does alcohol on the complex task of operating a motor vehicle.

DEC Category: CNS depressant

DEC Profile: Data not available; however, the profile for a CNS depressant is: horizontal gaze nystagmus present; vertical gaze nystagmus present at high doses; lack of convergence present; pupil size normal; reaction to light slow; pulse rate normal; blood pressure normal; body temperature normal. Diphenhydramine may produce dilated pupils.

Panel’s Assessment of Driving Risks: Single therapeutic doses of diphenhydramine have been shown to significantly impair psychomotor performance during the first 4 hours, and may have a greater impact on driving performance than alcohol.


References and Recommended Reading:

Baselt RC. Drug effects on psychomotor performance. Biomedical Publications, Foster City, CA; pp 137-43;2001.

Burns M, Wilkinson C. Laboratory study of drug-related performance changes. J Occup Med 1990;33(4): 320-6.

Drug Facts and Comparisons. Facts and comparisons, Saint Louis, MO; 1996.

Friedel B, Joo S, Reker K, Kadding W, Klostermann P, Saternus KS, Schneider V. Test drivers in the Daimler-Benz driving simulator with drivers under diphenhydramine. DOT HS 807 688 pp 1-162; 1991.

Gengo FM, Manning C. A review of the effects of antihistamines on mental processes related to automobile driving. J Allergy Clin Immunol 1990;86:1034-9.

Gengo F, Gabos C, Miller JK. The pharmacodynamics of diphenhydramine-induced drowsiness and changes in mental performances. Clin Pharmacol Ther 1989;45:15-21.

Hardman JG, Limbird LE (ed’s). Goodman & Gilman’s The Pharmacological Basis of Therapeutics. McGraw-Hill, NY, NY; 1996.

Moskowitz H, Burns M. Effects of terfenadine, diphenhydramine, and placebo on skills performance. Cutis 1988;42(4A):14-8.

O’Hanlon JF, Ramaekers JG. Antihistamine effects on actual driving performance in a standard test: a summary of Dutch experience, 1989-94. Allergy 1995;50:234-42.

Physicians’ Desk Reference, Medical Economics Company, Montvale, NJ, 2002.

Ramaekers JG, O'Hanlon JF. Acrivastine, terfenadine and diphenhydramine effects on several aspects of actual driving performance as a function of dose and time after dosing. Eur J Clin Pharmacol 1994;42:363-9.

Ramaekers JG. Behavioral toxicity of medicinal drugs. Drug Safety 1998;18:189-208.

Rice VJ, Snyder HL. The effects of benadryl and hismanal on psychomotor performance and perceived performance. Aviat Space Environ Med 1993;64:726-34.

Simons FER. H1 receptor antagonists. Comparative tolerability and safety. Drug Safety 1994;10:350-80.

Vuurman EFPM, Van Veggel LMA, Uiterwijk MMC, Leutner D, O'Hanlon JF. Effects of semprex-D and diphenhydramine on learning in young adults with seasonal allergic rhinitis. Allergy Asthma Immunol 1993;76:247-52.

Weiler JM, Bloomfield JR, Woodworth GG, Grant AR, Layton TA, Brown TL, McKenzie DR, Baker TW, Watson GS. Effects of fexofenadine, diphenhydramine, and alcohol on driving performance. A randomized, placebo-controlled trial in the Iowa Driving Simulator. Ann Intern Med 2000;132(5):354-63.

Witek TJ Jr, Canestrari DA, Miller RD, Yang JY, Riker DK. Characterization of daytime sleepiness and psychomotor performance following H1 receptor antagonists. Allergy Asthma Immunol 1995;74(5):419-26.


10 comments:

  1. The risk of death re the calpol is more so as a result of kidney or liver damage, the contraindications point this out, it does not say about sedation effects or if it does it is not the primary concern.
    I think two doctors, one of whom is a trained aneathetist would have m,ore suitable drugs at their disposal than calpol.

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  2. For reference: Calpol Night was first authorised/released in the uk on 12 January 2007 and not in September 2007 as someone keeps posting. Perhaps they really are retarded as Textusa implied?

    See this link: http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=20133

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  3. God knows for how long those children Madeleine in particular, were being given that or any other medication to ease them into sleep, so there would not be any hassle for the parents at night time? It could have been accumulating in their little bodies, and causing damage to internal organs, leading to a fatal outcome.

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  4. Ah was it calpol thou kate was a trained aneathetist good at putting people to sleep .wasn`t there a syringe found aswell.

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  5. As an anaethetist & GP Kate was equipped to self prescribe to (as she said) 'put the children to sleep at 7.30 p.m. each night'.

    'Sleepers' such as tablet form Temazepam are swift in effect, easily to disguise crushed in food - hence abuse in it's use in care of the elderly to 'shut them up'.

    The amount of Calpol required to make a child drowsy would, due to it's syrupy sweetness, induce stomach churning, vomitting and liver damage.

    Madeleine apparently slept soundly from being 'put to sleep'at 7.30 p.m. (to accomodate her parents' departure) until Mrs Fenn heard her start crying around 10.30 a.m. Her comatozed siblings stayed undisturbed. Mr Amaral has never speculated on the name of the medication which caused the comatozed state of the twins he and his officers witnessed on arrival. Nor would he as a competent officer with a law degree.

    Substantial amount of cadaver hair was reported (amongst car boot specimens); results were withheld from PJ and their request for specimen return for analysis in Portugal was blocked. Only one logical explanation exists for such corruption.

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  6. anonymous - 11:36

    Over sedation did not cause the forensic specimens analyzed in Madeleine's tragedy .. external blood loss.

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  7. I have been thinking and this is what has occured to me....if as we know they have, the McCanns have access to assistance from within the Britsih government, the forensic lab in Birmingham and it would seem the British constabulary, wouldnt it have been easier to have used these forces to cover up a cause of death by using these people they have access to to fuck up an inquest?
    And would like to know the following if anyone knows the answer...if Madeleine had have been found dead in the apartment what would be the protocol in Portugal? Would they have had an autorsy and inquest or would that be left for Britain to do?

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  8. Calpol night (discontinued in the UK)http://www.netdoctor.co.uk/aches-and-pains/medicines/calpol-night.html

    Calpol Night WAS available pre May 2007 after approval for launch in Jan 07 http://www.mhra.gov.uk/home/groups/l-unit1/documents/websiteresources/con014180.pdf

    Public Assessment Report
    Calcold
    Calpol Night
    Calcold Sachets
    Paracetamol, diphenhydramine hydrochloride

    Calpol Night TV advert (2007) http://www.tellyads.com/show_movie.php?filename=TA5684&advertiser=Calpol

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  9. quick references http://www.mhra.gov.uk/home/groups/l-reg/documents/licensing/con2030333.pdf

    http://web.archive.org/web/20071014061750/http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=20133#NUMBER

    ReplyDelete